Why are abdominal hernias dangerous and when is surgery needed?

Abdominal hernia is considered one of the most common ailments. The disease is typical for every person. There are many varieties of the disease. Each of them has its own first symptoms. It is worth noting that the disease can cause discomfort.

An abdominal hernia is a disease characterized by protrusion of organs from the abdominal cavity to the surface. Organs can be directed to the hernial orifice. What is a hernial orifice? These are some clearings that appear on the wall of the abdomen. Such defects can occur not only naturally, but also as a result of surgery or other trauma.

According to statistics, about five percent of the world's population suffers from various types of hernia. It is worth noting that eighty percent of patients are male. Most often, a hernia in the abdomen occurs in people of preschool age or people who have passed the fifty-year threshold. It has certain varieties. It is worth noting that the classification is very broad. If we talk about internal hernia, it is detected in 25% of cases. In another case, the hernia is external. Among the frequent phenomena, a hernia of the ventral type has been noticed. This is a postoperative hernia. It most often appears during surgical intervention.

Symptoms of the disease

It is important to know that the disease never appears asymptomatically. There is always a cause and symptoms of an abdominal hernia. The disease occurs over time. It can be both fulfilling and disposing.

If you look at the stomach, the symptoms will be visible in this place. They will differ in specificity, so the disease can be diagnosed very quickly. The hernial sac that appears in this area is visually visible. It can grow and reach very large sizes. The patient will also feel severe pain when inhaling. They can also occur when coughing.

The first symptoms of a hernia in the lower abdomen can be identified quickly, which cannot be said about an inguinal or perineal type formation. They have other indications:

• hernial protrusion resembling a tumor. It may be noticeable during exercise;
• the hernia begins to hurt, pulling and aching;
• urination is impaired;
• the digestive process suffers. Bloating, constipation, loose stools, vomiting and nausea may occur. The person begins to suffer from continuous belching.

A woman develops a perineal hernia. It is accompanied by a feeling of tightness and discomfort in the form of heaviness. Discomfort is felt in the area of ​​the rectum. Urination is impaired, and defects become noticeable on the skin. It hurts for a person to sit, the intestines become obstructed.

A man most often develops an inguinal hernia. A round formation grows near the scrotum. It can also be located inside it. Significant pain is felt, the hernial sac begins to press. The pain is sharp and gradually increasing.

Causes of the disease:

• heredity factor;
• a muscle defect that was very weak from birth;
• a consequence of injury, surgery, hunger. These factors can cause weak points in the human body.

All about hernias

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ALL ABOUT HERNIA

What is a "hernia"? A hernia is a protrusion of abdominal organs under the skin through weak spots in the abdominal wall. The exiting organs are located in the hernial sac formed by the peritoneum (the inner lining of the abdominal wall). The hernial sac can contain almost any organ of the abdominal cavity (intestinal loops, bladder, less often the stomach or part of it), the omentum, and extremely rarely the liver, spleen.

Rice.
Postoperative ventral hernia Why does a hernia form? The abdominal wall, consisting of muscles and aponeuroses, performs a number of functions, one of which is to hold the internal organs in their natural position and counteract the intra-abdominal pressure they create. Under the influence of intra-abdominal pressure, a defect (hernial orifice) can form in the weakest places of the abdominal wall, through which a hernia emerges. Predisposing factors may contribute to this, such as:

• Increases intra-abdominal pressure

1. excessive physical activity

2. severe cough, including chronic (smoker's cough)

3. constipation

4. diseases that cause shortness of breath with difficulty exhaling (bronchial asthma)

• Conditions and diseases associated with the development of connective tissue weakness (obesity, varicose veins of the legs, congenital connective tissue pathologies, hereditary predisposition)
• Patients who have previously been operated on for hernias are also at risk due to predisposing factors
• The formation of a hernia may go unnoticed, or may be accompanied by intense pain. Subsequently, under the influence of the same factors, a gradual increase in the hernia occurs, until most of the abdominal organs exit into the hernial sac.

Who can get a hernia? A hernia can occur in anyone, regardless of gender and age. External signs and symptoms. External manifestations and symptoms of hernias can develop gradually or occur within a short time.

• A feeling of pressure, weakness or pain in the abdomen, groin area or scrotum, which occurs or intensifies with physical activity or straining.
• A visually detectable “bulging”, a bulge in the abdomen, in the groin area, or scrotum, which appears or increases in size during physical activity or straining. Also, in the area of ​​the above formations, a feeling of discomfort or pain may appear during physical activity, coughing, or straining.

If you have any of the above symptoms, you should consult your doctor. The sooner the diagnosis is made and treatment is carried out, the higher the chance of preventing the development of complications, sometimes fatal.

Read more about types of hernias.

Rice. Classification of hernias of the anterior abdominal wall

Lumbar hernia of the anterior abdominal wall A lumbar hernia of the abdomen (Hernia lumbalis) is considered to be a hernia formation on the posterior, lateral walls (in the lumbar region), emerging through various weak points of the lateral abdominal wall. The main anatomical formations through which lumbar hernial formations occur are the Petit triangle and the Greenfelt-Lesgaft gap, aponeurotic fissures. Petit's triangle is bounded posteriorly by the outer edge of the vastus dorsi muscle, anteriorly by the inner edge of the external oblique muscle, and inferiorly by the iliac crest. In the area of ​​Petit's triangle, under the superficial fascia and thin aponeurosis, there is an internal oblique muscle. The Greenfelt-Lesgaft interval is often quadrangular in shape. Its upper border is made up of the lower serratus posterior muscle and the XII rib, medially it is delimited by the longitudinal muscles of the spine, the quadratus lumborum muscle, and the edge of the internal oblique muscle runs in front and below. The shape and size of the gap can vary depending on the length of the XII rib - with a long rib, the Greenfelt-Lesgaft gap is sometimes absent or looks like a gap, and with a short rib it increases in size. Aponeurotic fissures usually form at the site of passage of blood vessels and nerves, but can sometimes appear as a result of rupture or abnormal development of the aponeurosis. Among the causative factors contributing to the occurrence of hernia formation in these areas is weakness of connective tissue and muscle atrophy, inflammatory processes. Hernial protrusions occur on the left more often than on the right; bilateral ones are rare.

Recurrent hernias are a complication of surgical treatment of hernias. The causes of recurrent hernial protrusion may be related to the patient’s lifestyle and structural features of his body.

For example: failure to comply with the terms of the recovery period, when a person begins active physical activity ahead of schedule. With age-related changes and a number of pathological conditions, when tissues can become flabby, change elasticity and structure, which also affects the quality and duration of healing after surgery. Thus, in elderly, exhausted or very obese patients, relapses can be observed regardless of the method of operation and the course of the postoperative period. The main reasons for the formation of recurrent hernias:

• errors related to operational technology
• connective tissue deficiency
• wound infection during or after surgery
• excessive physical exertion, especially soon after surgery

The only treatment for recurrent hernias is surgery. In this case, various methods of hernioplasty using various mesh prostheses are selected.

Rice. Removal of old and deformed graft

Rice. Restoration of the integrity of the inguinal canal and reprosthetic hernioplasty according to Liechtenstein

Why is a hernia dangerous? In addition to the obvious inconvenience associated with the presence of a cosmetic defect, decreased physical activity and ability to work, a hernia carries the risk of developing a number of complications. These include dysfunctions of the organs located in the hernial sac - constipation, urination disorders, and when large volumes of organs leave the abdominal cavity - breathing problems. A serious complication is the development of a strangulated hernia. Strangulation is compression of the hernia in the hernial orifice, resulting in necrosis of the contents of the hernial sac. Incarceration is accompanied by sharp pain in the area of ​​the hernial protrusion. The most dangerous thing with strangulation is the development of intestinal obstruction (a loop of intestine is strangulated) and subsequent peritonitis. This situation requires immediate resolution through surgery. By and large, regardless of which organ is the content of the hernial sac, the final result without appropriate treatment is the same - peritonitis, the only difference is time. Peritonitis - inflammation of the peritoneum - is a serious complication of a large number of diseases, including strangulated hernias; the development of this pathological condition is one of the most difficult problems in surgery. Age, obesity, and the presence of concomitant pathologies further aggravate this situation. Without surgery, there is only one outcome - death. Even if the operation is performed, but more than a day has passed since the onset of the strangulation, up to 30% of patients die in the postoperative period. There is no need to bring such a small problem as a hernia to such a tragic situation.

How is a hernia treated? The only way to treat a hernia in adult patients is to perform surgery (hernia repair).

When should hernia treatment begin? Following from the above, the earlier the operation is performed, the better.

Is it possible to do without surgery? -No. For adult patients with a hernia, the only treatment option is surgery.

Are there any contraindications for surgery? Hernia repair cannot be performed in the presence of severe concomitant pathology, when the operation can only harm and not help. Such cases include: the coming months after myocardial infarction, stroke, and a number of other extremely severe concomitant pathologies. It should be remembered that the presence of chronic diseases is not an absolute contraindication to surgery, but only requires appropriate correction in the preoperative period.

Is it possible to perform other surgical interventions simultaneously with hernia surgery? Yes. Hernia surgery can be supplemented with almost any surgical intervention. Often, especially in older patients, there are several problems that require surgical intervention. In such situations, it is preferable to get by with one operation that combines the removal of the hernia and some other problem. Performing combined operations is a priority method, as it allows you to solve two (or more) problems in one surgical intervention and relieves the patient of psycho-emotional problems associated with the need to undergo several operations.

What types of operations are performed to repair a hernia? Today, more than 300 methods of hernia repair are known - ventral, inguinal, umbilical, femoral, postoperative. But all of them can fundamentally be divided into two groups:

• with plastic surgery using one’s own tissues – the tissue of the abdominal wall around it is used to close the hernial opening
• with plastic surgery using synthetic materials (or plastic surgery “without tension”) - synthetic prostheses made from surgical threads are used to close the hernial opening.

Plastic surgery with one’s own tissues is the oldest group of methods, born in the second half of the 19th century, it is the most extensive and widespread. Its essence is to close the hernial orifice with the patient’s own tissues (muscles, fascia and aponeuroses) in one way or another. The frequency of hernia recurrence after these operations varies from 20% to 70% depending on the condition of the patient’s tissues, the method of hernioplasty and the correctness of its choice. The main disadvantages are severe pain in the first days after surgery due to tissue tension and long periods of physical rehabilitation. Intense physical labor is contraindicated for at least 3 months after surgery.

Methods of plastic surgery “without tension” of the patient’s own tissues have existed since the second half of the 60s of the twentieth century. What distinguishes them from methods of plastic surgery using one’s own tissues is the use of “patches” made of synthetic materials to close the hernial orifice. In recent years, these methods have gained great popularity, which became possible thanks to the creation of advanced synthetic materials and the development of new methods for closing the hernial orifice, which practically guarantee the patient against recurrence of the hernia. The relapse rate does not exceed 1% in specialized clinics, regardless of the type of hernia. Despite the skin incision over the hernia, pain after surgery is minimal, because there is no tension on your own tissues. Intense physical labor is possible a month after the operation, household physical activity is not limited. This allows such operations to be performed on an outpatient basis. A positive point is also the possibility of performing the operation under local or spinal anesthesia, which is especially important for elderly patients and patients with heart and lung diseases. Hernioplasty using the ILLichtenstein method for inguinal hernias has become most widespread due to its reliability and simplicity. It is applicable for any type and size of inguinal hernia.

Rice. Plastic surgery of the inguinal canal with a mesh polypropylene prosthesis according to Liechtenstein.

It is also worth mentioning laparoscopic (through punctures of the anterior abdominal wall) methods of hernia repair. These are operations that are performed under the control of a laparoscope - a device that allows, using a mini-video camera, to eliminate a hernia from the abdominal cavity without making an incision in the skin over the hernia. They were born in the early 80s of the twentieth century with the advent of video technology. In most cases, the abdominal wall defect is closed from the inside of the abdominal cavity with a synthetic mesh prosthesis. The frequency of hernia recurrence after this repair is 2-5%, which is determined by the type of hernia and the preparedness of the surgeons. The important advantages of these methods are low trauma, which means minor pain after surgery, short rehabilitation periods (up to a month for physical labor), as well as the ability to perform bilateral plastic surgery and, if necessary, combined operations in the abdominal cavity through the same punctures in the abdominal wall. Serious disadvantages of this group of methods include the need for general anesthesia (anesthesia), the need to inject gas into the abdominal cavity to create an operative space (dangerous in patients with lung and heart diseases).

Performing reasons

This type of reason differs in that the level of pressure inside the womb increases inside the body. A hernia begins to develop in weakened areas on the anterior wall of the abdomen:

• stable physical loads on the body;
• presence of extra pounds;
• the occurrence of tumors in the abdominal area;
• chronic cough that occurs due to lung diseases;
• problems with urination;
• presence of constipation;
• pregnancy and difficult childbirth;
• diseases such as cirrhosis, tuberculosis, etc.

The disease can only appear when one of these causes is present in a person for a long period of time.

How to determine a spinal hernia yourself

It is clear that at home you can only suspect that you or your relatives have problems with intervertebral discs. But only a doctor can make an accurate diagnosis. This could be a therapist, orthopedist or neurologist. Just in case, you can take a closer look at your behavior, postures, movements, so that when examining and collecting an anamnesis, you can operate with clear facts that will help you more clearly determine the stage, and often the diagnosis.

In addition to pain, tingling, cramps, you need to take a closer look at how a person sits down, stands up, and how smoothly he moves. The pain syndrome forces you to act extremely carefully. In addition, areas where symptoms of a hernia are observed are indicative. So, if the inner side of the thigh begins to hurt, most likely one of the vertebrae in the lower part of the lower back has been damaged. But a lesion in the cervical region will affect the upper extremities, which will become numb and painful. If you notice any warning signs, do not delay visiting your doctor.

Diagnosis of the disease

When you suspect a pathology, you must urgently seek advice from a specialist who will prescribe an examination in combination with ultrasound and tests. It is very easy to identify the disease when it appears in standard, familiar places of its formation. It could be the navel, groin, thigh. If the hernia is of the ventral type, then it can be recognized based on the symptom of a cough impulse. A hand is placed on the tubercle, the patient must cough. At that moment, the doctor may feel tremors. The disease can be detected by palpation. Sometimes the doctor may feel or tap the affected area.

Diagnosis of spinal hernia by symptoms

A visit to a specialist begins with a detailed questioning, feeling the back, vertebrae, and determining reflexes in the Achilles tendon and knees. You will also have to undergo hardware tests. Typically, the patient is sent:

• for radiography
• Ultrasound
• Clinics also use tomographs, which provide visual confirmation of the primary diagnosis.

The condition of the nerves and the quality of their work are determined using an electroneuromyographic study. A comprehensive study of how a hernia manifests itself helps to prescribe adequate treatment. There are many ways to check the spine. The method of its treatment is the same. Therefore, you should not bring yourself to irreparable consequences.

Important! Consequences of an untreated hernia

If the disease is left to chance, the situation will worsen from year to year. Radiculitis will occur, i.e. inflammation of the nerve fibers. Every movement will cause pain and shooting. The muscles will weaken, the limbs will lose mobility, and problems will arise with the fulfillment of natural needs.

Conservative treatment

Removal of this type of hernia is possible when it is necessary to relieve the patient from complications. Thus, the pathology stops growing, and the symptoms become less severe. This type is suitable only for those patients who are contraindicated for surgery due to age, another disease, or pregnant women.

The following measures are being taken:

• treatment with medications;
• combating the causes that provoke pressure inside the womb;
• diet food;
• special gymnastics;
• indication for wearing a bandage;
• special massage.

Examination methods for diagnosis

Diagnosing an inguinal hernia is not difficult. By collecting a detailed history of the disease and life, and an objective examination, a preliminary diagnosis is made.

To clarify, additional examination methods .

• Laboratory tests (general analysis and blood biochemistry, liver tests, coagulogram, general urinalysis) - prescribed to identify the degree of severity, in preoperative preparation to assess possible risks during surgery;
• Ultrasound of the abdominal organs, pelvis, inguinal canal, scrotum - allows you to visualize the contents of the hernial sac, differentiate an inguinal hernia from other diseases, clarify the type, assess the condition of the inguinal canal and the organs involved;
• Herniography - an X-ray examination with contrast is performed for an internal inguinal hernia, when there are complaints of pain in the groin area, but there is no obvious protrusion;
• Irrigoscopy – X-ray contrast examination of the colon to determine its location;
• Cystography is an X-ray examination of the bladder with the introduction of a contrast agent, prescribed for suspected sliding inguinal hernia involving the urinary system;
• Computed tomography - allows you to accurately localize the hernial orifice, determine the contents of the hernial sac, and is performed in doubtful cases to verify the diagnosis.

The doctor who has diagnosed an inguinal hernia will tell you what to do next and select safe treatment with minimal risk of relapse, taking into account individual characteristics.

Effective Treatments

Easily reducible hernia contents give the false belief that the inguinal hernia has resolved on its own.

There are no conservative treatment options . An elastic bandage prevents strangulation, slows down the rate of progression of an inguinal hernia, surgical treatment completely neutralizes the pathological process, and reduces the risk of relapse to a minimum.

Incarceration with signs of an “acute” abdomen is a direct indication for emergency surgical care. The operation is performed as quickly as possible with minimal examination and preoperative preparation. Planned treatment of an inguinal hernia, the symptoms of which do not cause concern for the patient’s life, is carried out after a full examination.

Hernioplasty is performed using open access and laparoscopic methods .

The operation using the Lichtenstein method is a classic version of open repair, the “gold ” standard , which is effective for hernias of any size and location. Does not require general anesthesia. The protrusion is reduced without opening the hernial sac, after which a special mesh is installed to strengthen the structures of the inguinal canal. With this treatment, the risk of relapse is less than 1%. But in the first days after the operation, pain may be expressed; in the long term, chronic abdominal pain is sometimes bothersome.

A less invasive way to eliminate an inguinal hernia are laparoscopic techniques: transabdominal preperitoneal repair (TAPP), total extraperitoneal repair (TEP).

Access is made through three small punctures in the abdominal wall, which ensures quick recovery and minimal cosmetic defects. The operation is performed under general anesthesia using an endoscopic unit. An ideal correction option for a bilateral process. The intensity of pain after surgery is significantly lower.

Surgical treatment

This method is considered the only effective one for this disease. It involves surgical intervention for hernia removal.

There is only one type of disease that can resolve on its own. This is a baby umbilical hernia. Adults don't have it. It is typical for children under five years of age. In another case, if the operation is not performed, the pathology may increase and cause a threat to human health.

At the first symptoms, you need to immediately go to the surgeon in order not to start the disease. If the operation is performed on time, there is a high chance of recovery.

How is the surgeon examined?

Diagnosis of an inguinal hernia begins with a questioning of the patient and his further examination. During the interview, the doctor finds out what exactly the patient is complaining about, how long he has been bothered by the listed phenomena, with what frequency, what precedes and causes them. Also, during the survey, factors contributing to the development of a hernia can be identified: conditions and characteristics of life, professional activity, leisure, the presence of injuries and surgical interventions in the past. The surgeon may ask whether any immediate relatives have suffered from a hernia, and this is not an idle question: the hernia itself, of course, is not inherited, but the specific structure of the ligaments, aponeuroses (connective tissue) and muscle tissue of the area can be passed on from the parents to the child groin Therefore, one can often see the “familial” nature of an inguinal hernia, which is explained by the elementary inheritance of the characteristic weakness of certain areas of the abdominal wall.

During the examination, the doctor assesses the size and shape of the hernia, and does this in different body positions: when the patient is standing and lying down. Pay attention to the skin above and around the formation: the presence of dilated veins, diaper rash, scratching and other damage. In obese patients, such an examination is difficult because, due to the large thickness of the fat layer on the abdomen, the hernia becomes invisible to examination. In addition, at the time of examination, the hernia may “slip” into the abdominal cavity. Therefore, after the examination, palpation (feeling) of the groin should be performed.

During palpation the following is determined:

• what is the shape of the hernia, its size, how does it change if the patient coughs or strains;
• is it possible to move the mass back into the abdominal cavity;
• does the hernia hurt when touched?
• whether the scrotum and testicles in it are enlarged, in what condition are the spermatic cords;
• what about the inguinal canal - with hernias it can increase significantly;
• condition of the lymph nodes in the groin area.

It is during palpation that, as a rule, the type of inguinal hernia is accurately determined, as well as its difference from other diseases in this area.

Risk factors

— Hereditary genetic factor. - Chronic cough and sneezing. - Tuberculosis. - Chronic constipation. - Enlarged prostate. - Obesity. - Liver diseases, such as cirrhosis. - Lack of protein. - Lifting weights. — Smoking (increases the risk of developing the disease). —Patients suffering from polio or paraplegia are prone to the disease due to muscle weakness. — Weakness of muscles due to old age. — Postoperative infection in a wound with poorly fused muscles, which leads to weakness of the abdominal wall and, accordingly, to a hernia. — Accidental nerve damage during appendicitis surgery. - Certain yoga or aerobics exercises. At the same time, cycling or exercising on an exercise bike does not lead to the formation of pathology.